Question
Hi again.

Today, I received my first cortisone shot for my right-foot neuroma, but I had discouraging results. I couldn抰 pinpoint a certain source of pain, because I can feel a little annoyance between every toe, therefore, he went between the 3rd and 4th as a first try. Unfortunately, the dull pain is still around.

I抦 befuddled as to what to do next. I抦 not sure if cortisone is ineffective, or he shot the wrong spot, and the pain is from neuromas in the other spaces. My worst fear is that it turns out to be multiple neuromas spanning all spaces. I guess the next thing to do is to try injecting the other spots.

I still plan on coming to see you one day, but I really hoped to pinpoint the source (if there is just 1 source) and make it easier for you.

How would I go about becoming a candidate for cryosurgery if I have nothing in terms of location to offer? Can the nerve stimulator detect sources of pain better than this trial-and-error, cortisone routine I抦 about to undergo?

Thanks,
Jeff


Answer
Hi Jeff,

It may take some time to see if the cortisone will be effective.  In some cases we try 2 or 3 injections.

Most patients have a hard time finding the exact source or location of foot pain from a neuroma.  That's the Drs job.  It is possible that the shot was not at the exact location or that you have several sources of pain or several neuromas.  There are also other possible nerves that may need to be checked.

Before I perform Cryosurgery on a patient I determine the location of the pain source with small amounts of anesthetic at different nerve sites.  For instance if the 3rd interspace is suspect, I will put a small amount of anesthetic and see the response.  If you get partial relief, I may put a little in the second space and see the results.  I will do this until I find the exact source or sources that give full pain relief.

If I cannot pinpoint the source then Cryosurgery is not an option.  However, it would be rare not to find the source.
The nerve stimulator does not find the source of pain it just locates any nerve whether it is a pain source or not.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com


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